It should be noted that this is an interim report. We recommend that the following actions be taken as part of future activities to better define and characterize past and future exposures to pesticides by military personnel:

• Answer to the extent possible the question of whether a biological/clinical correlation exists between undiagnosed illnesses among Gulf War veterans and pesticide exposure based on the HRA and biological plausibility relationships or lack thereof.

• Review the diagnoses contained in the approximately 28,000 Gulf War veteran inpatient records maintained at the National Personnel Records Center. Identify those records that might be pesticide exposure-related. Conduct a detailed analysis of any records with diagnoses that might be pesticides-related. Follow up with personnel who were hospitalized for possible pesticides exposures to determine their current health.

• Review exposure, biomonitoring, and health outcome data for chlorpyrifos available from various databases such as those at Environmental Protection Agency, Office of Pesticide Programs and the California EPA. Compare with chlorpyrifos results in HRA, and use as surrogate data for comparison to other pesticides.

• Compare in detail the exposure assessment results in the HRA with estimates and measurements from other published pesticide studies.

• Collect and analyze data on contemporary pesticide use by the military.

• Commission an epidemiological study of current and past military pesticide applicators, assessing levels of pesticide exposure and reported health effects.

• Investigate innovative technologies for improving methods for real-time and cumulative monitoring of pesticide exposure, and identify useful biomarkers to assist in post-exposure assessments.

• Evaluate the advisability of conducting a probabilistic risk assessment of pesticides as a refinement to the current HRA. This will better characterize uncertainty and variability in the risk assessment, and remove the inherent limitations of point estimates. For example, in some cases, a probabilistic risk assessment may demonstrate that more reliable high-exposure estimates are actually much lower than those now shown in the HRA. Before proceeding with a probabilistic risk assessment, however, it will be necessary to determine if, given the uncorrectable deficiencies of the data set, the improvements achievable will be sufficient to justify the effort.

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